Wal-Mart Disability Benefits Case Picked Up

WASHINGTON (CN) – A Wal-Mart worker who waited too long to seek disability benefits can take her case to the U.S. Supreme Court, the justices said Monday. Julie Heimeshoff had spent nearly 20 years with Wal-Mart and was working as a senior public relations manager when she claimed in 2005 that chronic pain and fibromyalgia-related fatigue had left her unable to continue working. Hartford Life and Accident Insurance Co. initially denied her claim for long-term disability benefits in December 2005 for failing to submit medical records that showed proof of loss. After Heimeshoff provided the requested functionality records, Hartford denied her claim again in November 2006. It said the records showed that she was not disabled under the plan. Heimeshoff appealed that determination and allegedly received a final denial letter in November 2007. She sued Hartford and Wal-Mart in November 2010, claiming that their failure to provide benefits amounted to violations of the Employee Retirement Income Security Act, or ERISA. A federal judge in Connecticut decided, however, that a three-year statute of limitations set out in the plan policy barred her action. “The plan unambiguously disallows legal action more than three years after the time written proof of loss is required to be furnished,” U.S. District Judge Janet Atherton wrote in January 2012. “Therefore, even crediting Ms. Heimeshoff’s argument regarding the uncertainty of written loss due dates, she could not take legal action any later than September 30, 2010. She filed her complaint on November 18, 2010, and it is therefore untimely under the terms of the plan policy.” Atherton also found that “Hartford was not required to inform Ms. Heimeshoff of the plan’s limitations period for legal action in its benefits determination letter, thus its failure to do so does not affect the untimeliness of Ms. Heimeshoff’s complaint.” The 2nd Circuit affirmed in September, rejecting Heimeshoff’s claim that Hartford’s final of denial of benefits actually started the clock on her time to sue. “Hartford’s plan provided that its three-year limitations period ran from the time that proof of loss was due under the plan,” the unsigned opinion states. “The policy language is unambiguous and it does not offend the statute to have the limitations period begin to run before the claim accrues. Appellant filed her claim challenging the denial of long-term disability benefits more than three years after her proof of loss was due. The court was also unsympathetic to Heimeshoff’s claim that Hartford concealed the time limits in its denial of benefits letters. “We need not address this issue,” the judges wrote. “Appellant’s counsel conceded in the district court and at oral argument that he had received a copy of the plan containing the unambiguous limitations provision long before the three-year period for appellant to bring the claim had expired. Thus, appellant is not entitled to equitable tolling.” The Supreme Court granted Heimeshoff a writ of certiorari on Monday.